Billing Insurance for Massage

Comment

Comment by Seth McLaughlin on October 17, 2009 at 9:53am

I've had some success filing insurance but have found that it requires a lot of time. I've had a few times that services were even prior authorized but then I wasn't paid. Now, I only take it for worker's comp or car accidents because most other direct billing hasn't been successful. There's definitely a learning curve for filing claims. You'll have a few that won't be successful that will tick you off and that will teach you sooooooooo much. I always feel like I have won something when I get the insurance check.
Be really really careful in your documentation. I've had my reimbursement cut because my chart notes talked about working on another area without documenting the relationship of that area on the injured site.

Comment by Michael on October 16, 2009 at 6:02am

Thank you everyone, especially Vivian. I actually have your book, Comprehensive Guide to Insurance Billing and Practice Building Tips for Massage Therapists. I received it when I picked up Massage Office Professional last year. It has, as well as peoples success stories, been my inspiration since I know it can be done yet people shy away from it. It is a distinct opportunity and I am to stubborn to shy away from a challenge. :) I will go through the articles and continue forward!

Comment by Vivian Madison Mahoney on October 15, 2009 at 10:09pm

Sorry, correction. In WA it is not an "any willing provider law" I meant to write "Every Category Provider" law.
Columbia school was in SC .

A couple more things. Be sure you use CPT codes within our scope of practice and that varies state to state. Also know what codes are not to be used together.

Also be sure that you are absolutely sure you have obtained verification of coverage with any insurance the patient states they have except in a Workers' Comp case. In a W/C case you MUST have obtained AUTHORIZATION from the adjuster after prescription is in hand. Other than finding out if the policy is in effect, benefits left, what the co-pays and deductibles are you need not bother to call an insurance company for any information. Except as stated above for Work Comp cases.

Sorry for a few mess ups, hey it is late and we have spent way too many hours (8) sitting in Atlanta Airport, and on the plane trying to get to Portland OR to do a seminar this weekend. To say nothing of missing a plane due to lay over because of weather, then losing my first class seats we paid for with AMEX points award we saved forever fo. The plane was there but they had already given our seats to someone on a wait list. Then walking ourselves to death to find where we were supposed to be, only to be sent back to starting point and then finally squashed in between people for 6 hours and nothing to eat. I should live without that for a long time, ha. Well I listen to ya'all, all the time, your turn to listen to me! giggle... giggle...We will NEVER fly again unless it is an emergency....

Comment by Vivian Madison Mahoney on October 15, 2009 at 9:46pm

Michael and Lara and anyone else reading this. Everyone makes it so difficult when it is as simple as this. I know of NO state that does not allow reimbursement to an LMT for an auto insurance case, except that there have been a couple of cases in PA that have gone to court and court decided that the therapist was not licensed and therefore could not bill auto or any insurance. So that means in a few months when their licensing is set in place they should be ok.
Then as far as workers comp is concerned, there is only one state that does not let an LMT be reimbursed and that is NY. Some times they can if they have solid authorization. Next, the health care insurance companies do not allow massage practitioners be "in network or participating" providers. Some are even guided under Federal Rules that even supersced state laws like in FL and WA.

By the way, the only thing mandatory in WA unlike any other state is that because of their "any willing provider law" the insurance companies are required by law to allow LMP's to become in network providers, however, there is no law telling them HOW MANY massage practitioners they need to allow in the network and many of the networks are closed and have been for a very long time.

As for calling any insurance company and asking if they will pay a massage therapist, that is like asking anyone if they will place money in your hand. The answer is NO. They do not give out advice like this much like they most often will not tell anyone how much they will pay or what codes they will pay.

Michael I have sold many many of my manuals, home study courses and seminars on dvd to NC LMT's and have heard positive results from many of them over the past few years. I have presented at the Columbia School of Massage, some were from NC, I have had NC LMT's at my house to seminars and so I know they do it and successfully. As with most LMT's in most states, they do not share for whatever reason. Maybe they fell they had to pay for the information and do not feel it is up to them to provide it all for free to someone else.

I too cannot teach an entire seminar here on this message board but will tell you this, you can go to www.massagetoday.com and click on columnist and read the many articles I have written on insurance since 2001 and go to my website if you will, check it out and see what is available that will provide anyone with all they need to SUCCESSFULLY bill and be paid by insurance. Some main secrets to success in this field are as follows:
A. Be sure to know the types of cases that will pay, will not pay and those in between.
B. With the in between cases, know how to find out for SURE if they will pay or not and it is not by trusting an adjuster or a patient.
C. Be sure the patient has a written prescription from their physician and that the prescription is written as you need it to be for successful billing.
D. Be sure that the interview with the patient covers all bases.
E. Have your fees ethically and within reason set
F. Have your patient files prepared in advance so you know what you need when they walk in your doors.
G. Be sure your documentation for the treatment is legally sound and complete because medically prescribed cases are also legal cases.
H. Be sure that the claim form is current, that the form is properly completed because one thing missing will cause an insurer to refrain from paying for another 30 to 45 days. (Most all states have laws on the time alloted for an insurer to pay a claim (most are 30 but not all). The secret is a CLEAN CLAIM. Miss one thing or incorrectly submit the claim, information missing, incorrect information, outdated or no prescription and so much more, they can deny and delay until the information they need is submitted. When that happens that gives them another 30 days.

Go to my website if you will: www.massageinsurancebilling.com
Thanks for asking and know that with purchases or taking my classes comes FREE consultation for a year or more. I wish I could answer all questions but time is limited.
Viv


II

Comment by ABMP on October 15, 2009 at 9:04pm

Hi Michael,
You may want to post this topic on the forum. It may generate more dialog there than in blog format, as I know many people are very curious about this.

Lara

Comment by Eric Wilson on October 15, 2009 at 1:26pm

Hello Michael,
Just a thought since I dont Know how she ask and what the laws are in NC
Did she ask about with a perscription or under doctors orders did she also tell them you are independent of the Dr.? Did they ask if they had any massage benfits at all? Do they have proferred providers for these services
Biggest problem is I dont Know the laws so that is a tough question call the person that you know is doing well with insurance billing and go to thier office and maybe they will share with you what they needed to do. But call and see how warm the water is first because some therapist are not forth coming with thier insight and knowledge